Topcat
#Topcat series#
Like other animated prime-time series ("The Flintstones", "The Jetsons", "Rocky & Bullwinkle"), this played to an adult audience as well as the kids which explains the wide appeal of this program, and its continued durability after 40+ years. The four DVD set contains all 30 original episodes, and includes the pilot about the gang's trip to Hawaii, as well as some priceless background information for the serious fanatic out there. From my point of view, the only apparent fault I could find was that some of the episodes could have much shorter though I am sure the purists out there would disagree. Despite the fact that the original run of this series was only from 1961-62, "TOP CAT" still has a cult following, as well as a high place on the top 100 Cartoons of All-Time. Additionally, TOPCAT still fails to demonstrate a significant reduction in death or all-cause hospitalizations.I must admit that I was never a big fan of this show, but after learning that at long last, Warner Home video had issued the COMPLETE SERIES on DVD recently, I just had to take a look especially since this may be the ONLY chance to view it unless my cable system decides to offer the Cartoon Network's BOOMERANG channel sometime soon. HF hospitalization: 20.8% vs 24.5%, HR 0.82 (0.67-0.99) (NNT=28 over 3.3 years)Įxclusion of the Russia/Georgia participants renders the primary outcome statistically significant, but does not materially affect the effect estimate for the primary or secondary outcomes. Therefore, the results of the 'Americas' subgroup may be the most accurate reflection of the effect of spironolactone in HFpEF. This indicates that significantly more participants from Russia did not receive the study drug, and raises the potential of misconduct at these study sites. Russia/Georgia: 9.3% vs 8.4%, HR 1.10 (0.79-1.51)Ĭredibility of this subgroup effect has been increased by a substudy demonstrating that participants from Russia were far more likely than those from North America to have no detectable serum concentrations of spironolactone metabolites. Subgroup analysis: Primary outcome varied based on region (Americas vs Russia/Georgia, p<0.001 for interaction)Īmericas: Spironolactone 27.3% vs placebo 31.8%, HR 0.82 (0.69-0.98) (NNT=23)
Unclear risk of bias: Loss-to-follow-up on vital status ~4%
#Topcat trial#
Low risk of bias characteristics: Randomized, allocation-concealed, double-blind trial analyzed using intention-to-treat population Heart transplant recipient or currently implanted LVADĬhronic pulmonary disease: Requiring home O2 or PO steroids, hospitalization for exacerbation within 12 months, or significant in the opinion of the investigator Infiltrative or hypertrophic obstructive cardiomyopathy (HoCM) Hemodynamically significant uncorrected primary valvular heart disease Heart failure with preserved ejection fraction (HFpEF):ĭefined as a clinical syndrome of signs & symptoms of HF with normal systolic function (LVEF >50% & LV end-diastolic volume index 45% (measured within 6 months prior to randomization & after any prior ACS)Ĭontrolled SBP (100 pg/mL (or N-terminal pro-BNP >360 pg/mL) within 30 days, not explained by another disease entity The label of "HFpEF" does not yet offer an actionable management plan. In this context, spironolactone remains useful for patients with HFpEF & resistant hypertension. Consistent with other "negative" studies in HFpEF, the results of TOPCAT supports the notion that patients with "HFpEF" should receive symptomatic treatment for HF, & interventions to reduce morbidity & mortality according to the underlying etiology. Spironolactone does not noticeably improve quality of life in HFpEF. Bottom line: In patients with HFpEF, spironolactone did not reduce the risk of death or hospitalization over 3.3 years. Spironolactone for heart failure with preserved ejection fraction.